Discussions at GMHC2013 About Home Births and Traditional Birth Attendants

Over 2000 abstracts were submitted to the Global Maternal Health Conference 2013. Eventually, around 800 delegates from all around the world presented papers and posters on maternal health topics under the theme of “Quality of Care”.

While all the sessions and plenaries were thought-provoking, some of the sessions that I found especially interesting dealt with home birth attendance and the role of traditional birth attendants (TBAs).

Speakers from Nigeria, Pakistan, Burkina Faso, Ethiopia and Uganda all highlighted the role that TBAs continue to play in home deliveries. Just because a country’s Ministry of Health dictates that women should deliver at facilities does not mean that women will indeed deliver at facilities. The reality in many of these countries, quite like Haiti, where I work, is that as long as there are significant barriers to safe, affordable and accessible obstetric care, women will continue to turn to other older women whom they know and trust: traditional birth attendants.

Presenters from Bangladesh and Nigeria presented findings from promoting the use of clean delivery kits (CDKs) and the consequent impact on improving safe deliveries. The CDKs were promoted through social marketing to families who would then either take the kit to the facility or give it to the TBA for use in home births.

We heard from a practitioner in Ethiopia whose organization works with pastoralists in the remote Afar region to improve health outcomes by training TBAs and encouraging women to visit the maternity waiting rooms built close to the referral centers. The group had identified 6 harmful practices that TBAs practiced, often leading to maternal and neonatal deaths. When trained on safe practices, the TBAs realized that what they had been doing in the past may have led to deaths.

In Bangladesh, women, after child birth, are often allowed to bleed for a long time owing to the traditional belief that any blood that leaves the woman’s body after child birth is bad blood. The TBAs have since been trained on why that is dangerous for women.

Discussions on task-shifting in HRH must acknowledge the role that TBAs continue to play in communities where women do not seek facility-based care for various reasons. If working with the community and women is important, then so is understanding and respecting decisions that women make in why and how they seek services from traditional birth attendants.

Prof. Mahmoud Fathalla perhaps said it best when he said “more women have died from child birth than men have died fighting each other in battles.”

Learn more about the conference and access the conference presentations at www.gmhc2013.com.

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